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Grant C, Hagopian G, Ponce-Zepeda J, Chandan V, Pakbaz Z. A Journey From Appendicitis to a Rare Appendiceal Mucinous Neoplasm. J Community Hosp Intern Med Perspect 2023; 13:29-34. [PMID: 38596560 PMCID: PMC11000834 DOI: 10.55729/2000-9666.1253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/03/2023] [Accepted: 08/10/2023] [Indexed: 04/11/2024] Open
Abstract
We present here a 66-year-old Caucasian male whose persistent abdominal pain thought to be due to appendicitis and associated acute splanchnic thrombosis. He was initially managed with antibiotics and anticoagulation. But further work up revealed a low-grade appendiceal mucinous neoplasm causing the splanchnic vein thrombosis. Additionally, diagnosis and management of this rare tumor and appropriate work up for splanchnic thrombosis will be briefly reviewed here.
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Affiliation(s)
| | - Garo Hagopian
- University of California Irvine Medical Center, Orange, CA,
USA
| | - Joaquin Ponce-Zepeda
- University of California Irvine Medical Center, Orange, CA,
USA
- Department of Pathology, University of California Irvine School of Medicine, Orange, CA,
USA
| | - Vishal Chandan
- University of California Irvine Medical Center, Orange, CA,
USA
- Department of Pathology, University of California Irvine School of Medicine, Orange, CA,
USA
| | - Zahra Pakbaz
- University of California Irvine Medical Center, Orange, CA,
USA
- Division of Hematology/Oncology, University of California Irvine School of Medicine, Orange, CA,
USA
- CHAO Family Comprehensive Cancer Center, Orange, CA,
USA
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2
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Pylephlebitis: A Systematic Review on Etiology, Diagnosis, and Treatment of Infective Portal Vein Thrombosis. Diagnostics (Basel) 2023; 13:diagnostics13030429. [PMID: 36766534 PMCID: PMC9914785 DOI: 10.3390/diagnostics13030429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/20/2022] [Accepted: 01/21/2023] [Indexed: 01/27/2023] Open
Abstract
Pylephlebitis, defined as infective thrombophlebitis of the portal vein, is a rare condition with an incidence of 0.37-2.7 cases per 100,000 person-years, which can virtually complicate any intra-abdominal or pelvic infections that develop within areas drained by the portal venous circulation. The current systematic review aimed to investigate the etiology behind pylephlebitis in terms of pathogens involved and causative infective processes, and to report the most common symptoms at clinical presentation. We included 220 individuals derived from published cases between 1971 and 2022. Of these, 155 (70.5%) were male with a median age of 50 years. There were 27 (12.3%) patients under 18 years of age, 6 (2.7%) individuals younger than one year, and the youngest reported case was only 20 days old. The most frequently reported symptoms on admission were fever (75.5%) and abdominal pain (66.4%), with diverticulitis (26.5%) and acute appendicitis (22%) being the two most common causes. Pylephlebitis was caused by a single pathogen in 94 (42.8%) cases and polymicrobial in 60 (27.2%) cases. However, the responsible pathogen was not identified or not reported in 30% of the included patients. The most frequently isolated bacteria were Escherichia coli (25%), Bacteroides spp. (17%), and Streptococcus spp. (15%). The treatment of pylephlebitis consists initially of broad-spectrum antibiotics that should be tailored upon bacterial identification and continued for at least four to six weeks after symptom presentation. There is no recommendation for prescribing anticoagulants to all patients with pylephlebitis. However, they should be administered in patients with thrombosis progression on repeat imaging or persistent fever despite proper antibiotic therapy to increase the rates of thrombus resolution or decrease the overall mortality, which is approximately 14%.
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Suppurative Thrombosis of the Portal Vein (Pylephlebits): A Systematic Review of Literature. J Clin Med 2022; 11:jcm11174992. [PMID: 36078922 PMCID: PMC9456472 DOI: 10.3390/jcm11174992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022] Open
Abstract
Suppurative portal vein thrombosis (pylephlebitis) is an uncommon condition usually associated with an intra-abdominal infection or inflammatory process. In this study, we aimed to synthesize data on previously published cases according to the PRISMA guidelines. A total of 103 patients were included. Patients were more commonly male (71.8%) and had a mean age of 49 years. The most common infection associated with pylephlebitis was diverticulitis (n = 29, 28.2%), and Escherichia coli was the most isolated pathogen (n = 21, 20.4%). Blood cultures were positive in 64 cases (62.1%). The most common site of thrombosis was the main portal vein (PV) in 59 patients (57.3%), followed by the superior mesenteric vein (SMV) in 40 patients (38.8%) and the right branch of the PV in 30 patients (29.1%). Sepsis developed in 60 patients (58.3%). The mortality rate in our review was 8.7%, and independent risk factors for mortality were the presence of pertinent comorbidities (OR 5.5, p = 0.02), positive blood cultures (OR 2.2, p = 0.02), and sepsis (OR 17.2, p = 0.049).
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Piltcher-da-Silva R, Sasaki VL, Petry JF, Rhoden GV, Zangari MAC, Piltcher-Recuero M, de Melo Rocha G, Andriguetto PC, Aguilera YS, Coelho JCU. Mesenteric venous thrombosis in a pregnant woman at first trimester gestation: a case report. J Surg Case Rep 2022; 2022:rjac294. [PMID: 35755012 PMCID: PMC9215352 DOI: 10.1093/jscr/rjac294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/27/2022] [Indexed: 12/02/2022] Open
Abstract
Mesenteric vein thrombosis (MVT) in a pregnant patient is a rare condition that seems to be associated with the pregnancy pró-thrombotic state. This can lead to severe circumstances such as intestinal hemorrhagic ischemia, sepsis, abortion and death. Abdominal assessment is challenging due to the anatomical and physiological changes during pregnancy. MVT clinical and complementary evaluation are nonspecific, making essential an image exam. We report a case of a 33-years-old woman at 11 weeks of gestation. She sought medical evaluation due to abdominal pain and had an appendicitis diagnosis, which was treated by laparoscopic surgery. One week later, she came back complaining of nonspecific abdominal pain. So an extensive evaluation was made, and the diagnosis of MVT and intestinal ischemia was concluded. She underwent laparotomy exploration and anticoagulation, having a good evolution and so was discharged on the sixth post-operative day.
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Affiliation(s)
| | - Vivian Laís Sasaki
- General and Digestive Surgery Service, Hospital Nossa Senhora das Graças , Curitiba, Brazil
| | - João Francisco Petry
- General and Digestive Surgery Service, Hospital Nossa Senhora das Graças , Curitiba, Brazil
| | | | | | | | | | | | - Yan Sacha Aguilera
- General and Digestive Surgery Service, Hospital Nossa Senhora das Graças , Curitiba, Brazil
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Bachelani AM. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac092. [PMID: 35350217 PMCID: PMC8944718 DOI: 10.1093/jscr/rjac092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/27/2022] [Indexed: 11/25/2022] Open
Abstract
A 61-year-old woman presented to the hospital with a clinical picture consistent with acute appendicitis. During surgery, the appendix was found to be gangrenous and involved the appendiceal base, so an ileocecectomy was performed. Pathology revealed an incidental neuroendocrine tumor of the terminal ileum involving five of nine lymph nodes. The patient later developed mesenteric venous thrombosis but was diagnosed and treated promptly, and she is now doing well. There have been previous reports of small bowel neuroendocrine tumor resulting in bowel ischemia, usually due to fibrosis which can result in obstruction of the mesenteric vessels. However, this is the first known report of a small bowel neuroendocrine tumor presenting with appendicitis, which most likely was from an ischemic etiology. This case also demonstrates the importance of a high index of suspicion for mesenteric ischemia in patients with small bowel neuroendocrine tumor who present with acute abdominal pain.
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Affiliation(s)
- Arshad M Bachelani
- Correspondence address. Department of Surgery, Penn Highlands Mon Valley Hospital, 1163 Country Club Road, Monongahela, PA 15063, USA. Tel: +1-412-874-8057; Fax: +1-855-379-3131; E-mail:
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Khripun AI, Shurygin SN, Mironkov AB, Pryamikov AD. [Venous acute disturbance of mesenteric circulation: diagnosis and treatment]. Khirurgiia (Mosk) 2017:95-102. [PMID: 29286040 DOI: 10.17116/hirurgia20171295-102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- A I Khripun
- Chair of surgery and endoscopy of the Department of advanced medical training of the N.I. Pirogov's Russian National Research Medical University, Moscow
| | - S N Shurygin
- Chair of surgery and endoscopy of the Department of advanced medical training of the N.I. Pirogov's Russian National Research Medical University, Moscow
| | - A B Mironkov
- Chair of surgery and endoscopy of the Department of advanced medical training of the N.I. Pirogov's Russian National Research Medical University, Moscow; V.M. Buyanov's City Clinical Hospital, Moscow, Russia
| | - A D Pryamikov
- Chair of surgery and endoscopy of the Department of advanced medical training of the N.I. Pirogov's Russian National Research Medical University, Moscow; V.M. Buyanov's City Clinical Hospital, Moscow, Russia
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Lole Harris BH, Walsh JL, Nazir SA. Super-mesenteric-vein-expia-thrombosis, the clinical sequelae can be quite atrocious. Int J Adolesc Med Health 2016; 28:445-449. [PMID: 26356359 DOI: 10.1515/ijamh-2015-0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/02/2015] [Indexed: 01/16/2023]
Abstract
Superior mesenteric vein (SMV) thrombosis is a rare, potentially life-threatening complication of intra-abdominal infection. Here we present a case of massive SMV thrombosis secondary to appendicitis in a 13-year-old boy. He presented with vague abdominal pain and associated symptoms, persistently elevated serum inflammatory markers and a pyrexia of unknown origin. Sonography proved inconclusive, and a definitive diagnosis was made by abdominal contrast-enhanced computed tomography. He was treated with antibiotics and anticoagulation before interval elective laparoscopic appendectomy. The non-specific nature of the presenting symptoms makes SMV thrombosis an important differential to consider when dealing with such patients.
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Das P, Mukherjee R, Pathak D, Gangopadhyay A, Halder S, Singh SK. Tension pneumoperitoneum: a very rare complication of acute gangrenous appendicitis. Ann R Coll Surg Engl 2016; 98:e197-e199. [PMID: 27652797 DOI: 10.1308/rcsann.2016.0240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Tension pneumoperitoneum is a very rare consequence of acute gangrenous appendicitis. We report a case of a 32-year-old woman who presented with abdominal pain, progressively increasing abdominal distension, profound hemodynamic instability and ventilatory compromise. The diagnosis of tension pneumoperitoneum was confirmed by computed tomography, which showed compression of the intra-abdominal viscera and liver (saddlebag sign) by a large volume of intraperitoneal free air. Urgent needle decompression was done as an emergency measure. Exploratory laparotomy, planned due to persistent peritonitis, revealed gangrenous appendicitis with perforation near its base. Appendicectomy with excision of gangrenous portion of caecum was performed. The purpose of the reporting this case is to highlight that the tension pneumoperitoneum can be, very rarely, associated with gangrenous appendicitis and timely diagnosis is very important for the emergency management of this deadly condition.
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Affiliation(s)
- P Das
- RG Kar Medical College , Kolkata, West Bengal , India
| | - R Mukherjee
- RG Kar Medical College , Kolkata, West Bengal , India
| | - D Pathak
- RG Kar Medical College , Kolkata, West Bengal , India
| | | | - S Halder
- RG Kar Medical College , Kolkata, West Bengal , India
| | - S K Singh
- RG Kar Medical College , Kolkata, West Bengal , India
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Pinto S, Lerner T, Lingamaneni G, Richards K. Superior mesenteric vein thrombosis as a complication of cecal diverticulitis: A case report. Int J Surg Case Rep 2016; 25:71-4. [PMID: 27332698 PMCID: PMC4917498 DOI: 10.1016/j.ijscr.2016.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/09/2016] [Accepted: 06/09/2016] [Indexed: 01/16/2023] Open
Abstract
Pylephlebitis is an uncommon complication of uncontrolled intra-abdominal infection that is associated with high morbidity and mortality. We present our experience with a unique case of cecal diverticulitis and septic thrombophlebitis of the superior mesenteric vein that was promptly diagnosed with high-resolution imaging and blood cultures. Antibiotic and anticoagulation therapy was instituted on confirming the diagnosis with magnetic resonance imaging (MRI) to control the infection and prevent propagation of the thrombus. Our case report raises awareness about a rare and potentially fatal condition and provides appropriate imaging supplementation to aid in timely diagnosis.
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Affiliation(s)
- Soniya Pinto
- University of Illinois Chicago (Metropolitan Group Hospitals), Department of General Surgery, United States.
| | - Terrence Lerner
- Advocate Illinois Masonic Medical Center, Department of General Surgery, United States.
| | - Gowtham Lingamaneni
- University of Illinois Chicago (Metropolitan Group Hospitals), Department of General Surgery, United States.
| | - Ken Richards
- Mercy Hospital and Medical Center, Department of General Surgery, United States.
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10
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Harris J, Blackwood B, Pillai S, Chiu B. Mesenteric vein thrombosis following laparoscopic appendectomy. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Nasher O, Patel RV, Singh SJ. Retrograde trans-mesoappendicular selective subserosal laparoscopic appendicectomy. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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